HealthPartners Research Foundation, Minneapolis, MN 55440-1524, USA.
Prev Chronic Dis. 2012;9:E141. doi: 10.5888/pcd9.120009.
We developed a decision support tool that can guide the development of heart disease prevention programs to focus on the interventions that have the most potential to benefit populations. To use it, however, users need to know the prevalence of heart disease in the population that they wish to help. We sought to determine the accuracy with which the prevalence of heart disease can be estimated from health care claims data.
We compared estimates of disease prevalence based on insurance claims to estimates derived from manual health records in a stratified random sample of 480 patients aged 30 years or older who were enrolled at any time from August 1, 2007, through July 31, 2008 (N = 474,089) in HealthPartners insurance and had a HealthPartners Medical Group electronic record. We compared randomly selected development and validation samples to a subsample that was also enrolled on August 1, 2005 (n = 272,348). We also compared the records of patients who had a gap in enrollment of more than 31 days with those who did not, and compared patients who had no visits, only 1 visit, or 2 or more visits more than 31 days apart for heart disease.
Agreement between claims data and manual review was best in both the development and the validation samples (Cohen's κ, 0.92, 95% confidence interval [CI], 0.87-0.97; and Cohen's κ, 0.94, 95% CI, 0.89-0.98, respectively) when patients with only 1 visit were considered to have heart disease.
In this population, prevalence of heart disease can be estimated from claims data with acceptable accuracy.
我们开发了一种决策支持工具,可用于指导心脏病预防计划的制定,重点关注最有可能使人群受益的干预措施。但是,用户需要知道他们希望帮助的人群中心脏病的流行程度。我们旨在确定从医疗保健索赔数据中估算心脏病流行程度的准确性。
我们将基于保险索赔的疾病流行率估计与分层随机抽样的 480 名年龄在 30 岁或以上的患者的手动健康记录中的估计进行了比较,这些患者于 2007 年 8 月 1 日至 2008 年 7 月 31 日期间(N = 474,089)在 HealthPartners 保险中注册,并具有 HealthPartners Medical Group 电子记录。我们将随机选择的开发和验证样本与 2005 年 8 月 1 日也注册的子样本进行了比较(n = 272,348)。我们还比较了登记有超过 31 天的空白期的患者的记录和没有登记有超过 31 天的空白期的患者的记录,并且比较了没有就诊、只有 1 次就诊或 2 次或更多次就诊但两次就诊之间间隔超过 31 天的患者的就诊记录。
在开发和验证样本中,索赔数据与手动审核之间的一致性最好(Cohen's κ,0.92,95%置信区间[CI],0.87-0.97;和 Cohen's κ,0.94,95%CI,0.89-0.98,分别),当仅考虑 1 次就诊的患者患有心脏病时。
在该人群中,可以从索赔数据中以可接受的准确性估算心脏病的流行率。